Minutes of the Meeting of the Audit Committee held on Thursday 16 th July 2015 at King s Court, Chapel Street, King s Lynn

Transcription

1 Minutes of the Meeting of the Audit Committee held on Thursday 16 th July 2015 at King s Court, Chapel Street, King s Lynn Present: Hilary De Lyon (HDL) Lay Member (Audit), Chair Tony Burgess (TB) GP Governing Body member Rob Bennett (RB) Lay Member Audit & Finance In Attendance: John Ingham (JI) CFO Emma Kriehn-Morris (EKM) Finance Manager Jean Clark (JC) Head of Governance (minutes) Julie Sherwood (JS) Governance Officer Kevin Limn (KL) Internal Audit, TIAA Nichola Smith (NS) Auditor, Ernst & Young Tony Uttley (TU) Financial Accounts & Governance Director, NELCSU Rachel Pilsworth (RP) Assistant Head of Finance, NHS England attended from item Kate Barlow (KB) NELCSU Attended for Item Angela Rusbridge (AR) NELCSU Attended for Item Maggie Carter (MC) Head of Quality, WNCCG Attended for Item Declarations of Interest No new declarations were raised Apologies for absence Apologies were received from: Cathy Gale, Lay Member PPI, Lisa George, Local Counter Fraud Specialist, TIAA, Mark Hodgson, Audit Director EY Action HDL noted a concern with the new lay member not attending and stressed the importance of all audit members attending to ensure quoracy Minutes of the last meeting held on 27 th May 2015 The minutes were APPROVED with these amendments Confirmation of any part of the Minutes that is currently considered FOIA exempt There was no part of the minutes confirmed as exempt Action points from Minutes 64 - In relation to the Whistleblowing report at the last meeting, HDL asked if the CCG had received a response from the Trust. TB said he had escalated this there had been half a response to the clinical complaint but not to the larger issue about the atmosphere in the trust. 36 LG was still chasing response 38- most of the recommendations had been completed, but still issues with peripheral stores. Insufficient controls due to geography, so still some risks. More security has been introduced. JI has asked ICES contract lead to pick up. Keep on log. 39 on agenda 48 Committee would like to see action plan. Put on Sept meeting agenda 52 done 53 JI will pick up with SC, and Maggie may be able to update 56 review in September 60 did invite. Hilary will discuss with Ian the CoM self assessment. 62 KL said this was equally split 4 days per area. Next progress will report will 1

2 include details of where that activity has occurred. HDL asked for this to be circulated before the next meeting and asked for LG to provide written report even if not attending. 63 HDL explained it would not always be possible to start at 10am. Agreed to be flexible about the start time. The Committee NOTED the action log Internal Audit Internal Audit Progress Report KL apologised for the delays with the audits which had been for a number of reasons. He was disappointed with such little progress in Q1. On a positive note, he had had good discussions with the CSU in relation to access and he planned to share some of the follow up action plans with them. HDL asked about the implications of the delays; would it impact on delivery of the work plan. KL did not believe so as no work had been scheduled for Q2 and there were only 2 audits in Q4 GBAF and IG and they should be turned around quite quickly. He explained that it had been agreed with the CCG management team that the auditor would meet with the lead manager after issuing report as an extra step to clear final report. RB asked if there was anything the Audit Committee needed to be aware of at this stage. KL confirmed there was not. RB explained that QIPP delivery was critical for the CCG and asked when the report would be finalised. KL confirmed that all the Q1 audits would be completed in September. RB said the committee needed to see the recommendations as soon as possible. RB asked about access to the client portal. KL explained there was access with the administrators being JC and EKM but would check. HDL asked why there were so many recommendations not yet due. KL explained that it was the presentation of columns and agreed to review. Final Report: Key Financial Assurance KL said that a Reasonable Assurance opinion was given with the recommendations referring to the lack of a signed agreement with NELCSU; the CCG needed to finalise this and then to use contractual mechanism to monitor delivery. His observation was that it was possible that things could fall between the gaps when transferring between the CCG and the CSU. EKM said she had developed a schedule for all key tasks which made it clear who does what. This had been shared with the auditor. She gave assurances that all the actions had been completed. HDL suggested that the deadline for agreeing the CSU contract of the end of July looked unlikely now. JI agreed and felt September was more realistic. It was a conscious decision on behalf of the CCG not to sign the SLA given the concerns with delivery; committing to a longer term SLA was a bigger risk. The CCG had progressed discussions with senior management in the CSU and had more assurance. The KPIs were developed; he would not sign the SLA without these. HDL said it was disappointing but understood. JI explained that a signed SLA with the CSU was a key control to a number of audits so when that was in place, many recommendations should be actioned. HDL noted that simply sending an to ensure something happens was insufficient control. 2

3 EKM noted that page 7 referred to credit notes but as no more than 4 had been raised, she was surprised about the amount of auditor time spent on this. Final Report: Supplier Payments KL said Substantial Assurance opinion had been given with no priority 1 or 2 recommendations. RB felt the CCG should not be paying suppliers ahead of delivery. EKM felt this was a helpful recommendation which supported the action taken by the CCG. The CCG s track record with the Better Payment Code was very good. EKM confirmed all the actions had been completed within the timetables. HDL noted the issues with SBS. TU explained that the contract management sat with NHS England so it was difficult to address. NELCSU has reasonable relations with SBS so could help raise problems. EKM had asked if she could be involved in a user group; Rachel Pilsworth was looking into this. Final Report: CHC Maggie Carter, Kate Barlow and Angela Rusbridge joined the meeting. KL introduced the report with Limited Assurance opinion driven by 6 priority 2 recommendations. The Committee had already discussed the lack of a signed SLA with the CSU. The team were clearing the backlog, addressing the inaccuracy of some recording and controls were now working. There were also some issues raised by external audit in relation to the bulk scanning; the large files of folders and access difficulties. The CSU had now changed practice. RB said he was very concerned about the findings in report; CHC was an important area for the CCG. HDL asked about the bulk scanning. Kate Barlow explained this had been carried out externally and it had been a senior leadership decision. HDL asked to note this was a poor decision. KL suggested adding clarity to the CHC service specification. RB said the committee recognised these were historical issues and asked if there was anything the committee should still be concerned with. KL suggested picking this up with the follow up audit to give the committee assurance, including the new scanning enabled better access to legacy records. JI asked if there were risks to finding patient information. Kate Barlow confirmed that work with the auditors had demonstrated they were able to locate any record; some took more time to access. KL added that the new scanning process would bookmark records. RB asked if the consent forms were now on file. KL confirmed that additional sample tests showed this was the case. The policy of zero tolerance was working. Kate Barlow added that the only ones missing had been from the acute provider who had kept them. Since the audit, they had been requested for filing. RB noted the 28 day target was not being met and asked who was responsible for the delays. Kate Barlow explained there was a duty to have an MDT panel with professionals who knew the patient and because of the lack of resources in the local authority this was not being met. The CSU has raised this concern with the CCGs in relation to lack of social work input. Having been unable to recruit a social worker in the West, the CSU had put in place innovative solutions and had asked NHS England for support. Maggie Carter confirmed it would be good practice to have a social 3

4 worker in the team. They were working closely with Norfolk County Council (NCC) but because the post was fixed term it had proven difficult to recruit to. A complex case panel had been set up and they were now meeting the 28 day target. The Committee asked this was captured in a conversation with Harold Bodmer. Kate Barlow confirmed he was aware and that the issue remained on the weekly dashboard reported to CCGs. TB asked about financial risk. JI confirmed this was being picked up, but it could work either way round. It was vital to meet the 28 day target otherwise people would seek restitution. RB asked about the monthly reviews not being completed on time. Kate Barlow explained this was an issue with recording. JI said this was now a KPI that would be in the new SLA. Kate Barlow added it was also a national requirement. RB noted at the last meeting external audit had raised audit issues with accruals. They had made a recommendation to have individual care agreements (ICA) in place. He asked if this had been done. Kate Barlow said it was in progress and additional resource had been acquired to address the backlog. The Standard Operating Procedure stated that no payment could be made without an ICA in place. The team were developing a new system which would be more robust. This was being piloted with Norwich CCG and then would be rolled out. Maggie Carter raised concerns with the backlog of signing off ICAs going back to January and February. It was the CCG s understanding that these providers had not been paid. Often the information was insufficient to allow her to sign off, which should be addressed by CSU quality assurance. She would like to be involved in pilot. RB asked if the auditors could confirm all these changes were in place at the follow up audit. TB asked about the size of the backlog. This was in excess of 200 across all Norfolk CCGs. Additional resource was in place to address this by the end of September. The Committee asked for West Norfolk CCG s specific backlog. Kate Barlow explained there were not ICAs for re-charge from Norfolk County Council but they were moving to NHS contracts. These were not part of the 200 backlog cases and would provide those numbers. Angela Rusbridge explained the team were asking to have access to the NCC system. There had never been ICAs for these cases. JI said this was a major concern. HDL requested the continuing monitoring of these actions and asked for an update in September from Kate Barlow and Maggie Carter. KL would support the closing of actions. JI said he remained concerned about the reconciliation between the ledger and Broadcare. This was also noted by external audit. KL said this was out of scope for the current audit but would pick this up next year. Angela Rusbridge said a small variation would be expected, but looking across the year it was very small. She was very confident that Broadcare was accurate. KB/MC KL HDL thanked Kate Barlow and Angela Rusbridge for attendance. Final Report: Care Homes The follow up audit report was tabled. KL updated on progress - of the 11 recommendations 2 were still in progress of being implemented, 5 had been fully implemented. 4 were in discussion due to the movement in the environment since the original audit had been carried out. Page 5 Maggie Carter explained this was still outstanding but the CCG was chasing 4

5 care homes to return the quarterly templates by the end of September. HDL questioned moving the deadline for an urgent recommendation. KL said it was a view at the time that it needed to be addressed but as steps had been taken he was proposing to review as the quarterly data comes through. The priority had been to push for the data to be returned. The next step was to review the quality of returns. RB shared HDL concerns and asked for regular updates to see the improvements. KL would consider a follow up report for September. Page 6 this had been pushed back to the end of December. The CSU oversaw the contracts and at the time of follow up there was no further evidence. Maggie Carter explained this had now been put in the quality schedule but there was still a weakness in relation to contract monitoring. KL would like to see a formalisation of process for those contracts to happen. Maggie Carter noted that the contracts were up for renewal and work was underway to address this in the new contracts. JI confirmed this was happening on a Norfolk basis for CHC. The project manager updated last week. He was not sure there was sufficient resource in the CSU to monitor the current contract however. The Committee asked for information on monitoring the contracts. TB commented on recommendations 4 and 7 and the relationship with NCC. He was not convinced the CCG had a relationship with any other person than the individual monitoring residential homes. This was a potential risk. The Committee requested SMT consider an SLA. RB noted a number of similar issues arising in relation to working with NCC that needed addressing. Final Report: Collaborative Commissioning HDL noted there was no recommendation from a key finding. KL acknowledged this was not the best way to carry out a pan-norfolk audit. JC noted the report did not reflect the conversations the CCG had had with the auditor and was disappointed in the audit. RB asked if the action had been carried out. JC confirmed the terms of reference had been updated, but things were moving fast with the Networks and collaborative commissioning in the centre. The audit reflected a point in time. Counter Fraud Update KL gave a verbal report. It was agreed that once the report was completed Lisa George would put this on the TIAA web portal so JI can see and sign off. Some issues fell within the responsibility of the CSU and Tony Uttley and Harry Turner had shared a paper with TIAA to update. The auditors were comfortable with the actions taken. It was agreed that LG would provide a one page summary for future Committee meetings. JI explained the proactive work had been carried out on CHC and LG had sent the draft recommendations. There were a couple of high priority areas again adding to the concerns with CHC. This would come to the next meeting. JI noted the conversations previously at the committee in relation to counter fraud in primary care. NHS England provided a counter fraud update which JI had shared with LG for her to advise if there were any issues/concerns. This was particularly important with co-commissioning. The Committee NOTED the internal audit and counter fraud update and reports. ACTION 1: To review access to the TIAA client portal and the presentation of audit KL 5

6 recommendations in reports ACTION 2: To present all the audit reports from Q1 at the September meeting ACTION 3: To provide the CHC backlog number for West Norfolk CCG and the NCC re-charge cases and timeframe for moving to NHS contracts. To raise the issue of not having ICAs for re-charges at CHC QIPP Board ACTION 4: To update the Committee in September on progress with CHC audit recommendations ACTION 5: To report on progress with Care Homes audit at September meeting ACTION 6: To request information from the CSU on their process for monitoring care home contracts ACTION 7: To consider an SLA with NCC for monitoring nursing and residential homes KL Kate Barlow Kate Barlow KL MC MC External Audit Annual Audit Letter Nichola Smith presented the Annual audit letter, with the same unqualified opinion as reported in May. Three out of five Norfolk CCGs received a qualified opinion this year. The concerns remain as continuing healthcare. There were no additional fees. HDL thanked, on behalf of the committee, the finance team for all their hard work. She questioned whether the VFM conclusion should say 7.8 million this was confirmed. RB said these were a really good set of audit results and congratulations to the team and thanks to EY. It went really smoothly. JI noted on page 4, recommendation on QIPP, that this was a key part of the Finance & Performance Committee agenda. Audit Committee Briefing HDL noted how useful these briefings were. The Committee reviewed the questions these were added to the Audit Committee action log. The Committee NOTED the Annual Audit Letter and the briefing NEL CSU s Service Auditor Reporting (SAR) Tony Uttley, Financial Accounts & Governance Director at NELCSU explained that SAR was new to the CSU and aimed to provide assurance to CCGs on the effectiveness of key controls. There was no internal audit programme of CSUs, just a reliance on the NHS England internal audit report. It was clear that what counted as satisfactory evidence when providing different services for different customers was difficult. JI said he would welcome a common standard. TU explained the CSU were in discussion with Deloitte about the interpretation of the findings. The CSU would prefer a different style of presentation. NHS England had agreed the scope with Deloitte. JI said it was difficult for West Norfolk CCG to obtain the assurances it needed from a report for all CCG customers. There was a workshop on Monday with NHS England attending where this would be discussed. KL would 6

7 also be attending. RB asked for the full report to be circulated. He noted the timing was problematic; the CCG did not want to know of big issues with the SAR so late in the day. He wanted assurance that all key controls were being covered by either the SAR or TIAA and there were no gaps. JI agreed that it was too generic. With limited scope; it did not cover continuing healthcare. There was still an issue of local auditor access to the CSU as the SAR was meant to cover everything, but it did not. HDL commented that the CCGs had hoped the CSU was adopting more of the London systems to get the best service. JI agreed that was part of the selling point of NEL CSU. He felt it was not clear how NEL CSU management knew its own controls were working, so it was difficult to assure the CCGs. The Committee NOTED the report. ACTION 8: To circulate the full SAR to committee members JC Risk Management GBAF JC explained the risk owner checklist. HDL felt this was very useful and requested this was a standing paper. HDL asked if the risk ratings were equivalent e.g. home birth vs QEH in special measures. TB explained that although the home birth service impacted on few numbers, the risk to patient choice and CCG reputation was high. He acknowledged that the risk had been on the register some time but there had not been an opportunity to accelerate the work due to the CPT process. JI challenged that the rating for this risk was 20. JC acknowledged that there was an issue with the inherent risk once it has been established, it was not altered. This needed to be added to the Risk Owner checklist. RB suggested adding cancer waits and IAPT. Corporate Risk Register It was agreed to alter any current risks higher than the inherent risks. RB asked about the process for review of the Corporate Risk Register was this by SMT and did staff get involved. JC explained that SMT did review the register, staff were actively involved in updating and the Patient Safety & Clinical Quality Committee reviewed the quality risks each month. Kevin Limn noted that some of the tools of the Good Governance Institute were useful. He suggested producing an end of year report of the number of risks successfully mitigated to target rating. ACTION 9: JC to alter both risk registers in light of the comments, add the Risk Owner checklist as a standing item and producing end of year review of risks CCG Financial Governance Assurance Process JI explained the background to the assurance process and the changes to the assessment tool from NHS England. The CCG completed the original checklist and submitted by the original deadline and asked the Committee s thoughts on its self- JC 7

8 assessment. Rachel Pilsworth had provided comments which were helpful. HDL noted that it would have been better if NHS England had not changed the documentation and process and had given a reasonable timescale. Rachel Pilsworth agreed and had fed this back. The final submission was by 24 th July; then there would be regional validation. NHS England would adopt a red flag system to help provide support earlier on in process and would share good practice from other areas. EKM commented that she would not expect any surprises as the CCG worked closely with NHS England already. HDL asked if NHS England was going through same process. The Committee NOTED the draft submission Conflicts of Interest Committee Chair s Report and Minutes of April Meeting RB gave a verbal Chair s report and presented the minutes of the meeting in April. This was the first meeting following the committee s establishment and focused on its terms of reference and how to identify cases of potential conflict. Having had two meetings now, the key issue was how to ensure individuals understood what a conflict was and the importance of managing them. Training was important. HDL reflected it was particularly important with primary care commissioning. TB said that in past, GPs had simply excluded themselves but a more sophisticated approach was needed at the start of any programme of work. The Committee NOTED the report and minutes Health & Safety JC explained there was nothing to report this meeting. the H&S Policy had been approved by the Governing Body in June Capacity & Recruitment This was deferred to the September meeting Tender Waivers None to Report Losses & Compensations There were none to report Off Payroll disclosures Emma Kriehn-Morris explained the process the CCG had put in place by way of assurance that any off-payroll contractors were meeting statutory requirements and there were no disguised employees. She discussed the assessment form with any individuals that triggered the assessment and this gave a determination of whether that person was an employee or contractor. They signed the declaration that they were responsible for their tax affairs and had considered IR35. Two individuals had been taken through the process to date and had been reviewed by the Remuneration Committee The Committee NOTED the process. 8

9 15.76 Information Governance Committee Minutes 12 th May 2015 JI noted that our mental health provider had not achieved level 2 on the IG Toolkit but there was an action plan for compliance. This will be reviewed by the IG Committee. The Committee NOTED the minutes Patient Safety & Clinical Quality Committee Minutes 21 st April, 19 th May 2015 The Committee NOTED the minutes Finance & Performance Committee Minutes 13 th May 2015 The Committee NOTED the minutes Reflection on the meeting Members reflected that the July meeting would always be a long meeting as May focused on the annual accounts. RB felt it was important not to curtail the discussion but suggested that the Audit Committee briefing provided by EY could be considered in advance of the meeting and all papers could be taken as read. KL agreed to add more in the progress report allowing the internal audit reports to be for information. These can be circulated in advance of the meeting, when finalised. TB suggested preparing action points in advance and spending less time on them in the meeting. JC would send out action points to individuals to update. JC The Committee thanked Rachel Pilsworth for attending and thanked Jean Clark for her work in supporting the Audit Committee over the last year Any Other Business There were no items of any other business Date of next meeting: 23 rd September